Collaborative Intravenous Nursing Service (CINS) Guidelines

20G. Infiltrate the site with 1-3ml of 3%isotonic sodium thiosulphate into theaffected area using multiple ‘pincushion’ injections at several areasaround the circumference ofextravasated area. Beforeadministering Sodium Thiosulphatethe solution provided in the packMUST BE DILUTED FIRST. Dilute1.2ml 50% sodium thiosulphate to 20mlwith water for injectionThis is recommended for mustine i,ii,iii . The useseems well supported, and seems unlikely tocause any harm. It should be noted that sodiumthiosulphate is not licensed for this use.The evidence supporting this treatmentconsists entirely of III or IV reports but issufficiently extensive that this can berecommended at Grade B.H. Monitor patient closely for “recallreactions”.Anthracyclines administered after radiotherapyhave been shown in a reactivation of skintoxicity known as a “recall reaction”. A similarreaction may be seen in patients who have hadprevious extravasations. This reaction has alsobeen shown with paclitaxel ii .The evidence for this approach in patients onanthracyclines and Paclitaxel is very limited(level IV) and the confidence with which it canbe recommended is Grade C.Reproduced with thanks from the UKCCSG paediatric extravasation policyi Pharmacologic Management of Vesicant Chemotherapy Extravasations. CancerChemotherapy Handbook. 2 nd Edition. Chapter 6. Ed. Dorr R.T., Von Hoff D. Appleton &Lange, Norwalk, Conneticut.iiBertelli, G. Prevention and Management of Extravasation of Cytotoxic Drugs. Drug Safety12(4): 245-255. 1995.iiiDorr R.T. Antidotes to Vesicant Chemotherapy Extravasations. Blood Reviews 4: 41-60.1990.iv Kassner E. Evaluation and Treatment of Chemotherapy Extravasation Injuries. Journal ofPaediatric Oncology Nursing 17(3): 135-148. 2000.v Extravasation of drugs. Anaesthesia Review. Chapter 13. Ed. Kaufman L., Ginsbury R.Churchill Livingstone. 1997. London.viRospond R.M. Utilization of dimethyl sulfoxide for treating anthracycline extravasation. JOncol Pharm Practice 1(4): 33-39. 1995.viiLawrence H.J., et al. Topical dimethylsulfoxide may prevent tissue damage fromanthracycline extravasation. Cancer Chemotherapy and Pharmacology 23: 316-318. 1989.The CINs group hereby assert their moral rights tothe works herein in accordance with the Data Protection Act 1988.Policy review date 01/10/10